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Laparoscopic operations such as colectomy, appendicectomy and placement of peritoneal dialysis catheter have been described using a two laparoscopic port technique (one camera port and one working port).1–3 Intracorporeal knot tying is traditionally performed using two instruments, requiring three ports (one camera port and two working ports).4 This technical note describes the method of intracorporeal knot formation using only one instrument, and thus two ports.
The needle is passed through the defect and secured within the anterior abdominal wall opposite the instrument port (Fig. 1). The tail of the suture is passed over and backwards to the bight (Fig. 2). Ensure the bight is under tension as this will provide counter traction for tying. The instrument is passed through the loop and pulls the tail through (Fig. 3), forming a square knot. Repeated throws secure the knot down.
The technique describes laparoscopic intracorporeal knot tying using only one instrument, thereby eliminating the need for a third port. It is, therefore, most useful in two-port laparoscopic procedures (this method was employed in a diagnostic laparoscopy) and potentially when access with two instruments is difficult. Polyfilament sutures are most suited, as it allows easy manipulation of the tail end. Prolene sutures have a memory and, therefore, it can be difficult to throw the tail end of the suture over the bight. Additionally, by securing the needle to anterior abdominal wall, accidental damage to structures is minimised. We believe the method described is simple to master and quick to execute.